Midtrimester screening for microalbuminuria in healthy pregnant women

To ascertain the effectiveness and feasibility of testing for microalbuminuria and the albumin/creatinine ratio as an early indication of hypertensive disorders of pregnancy, we measured albumin and creatinine excretion in 95 healthy pregnant women between 16 and 20 weeks of pregnancy. Nine women developed hypertensive complications; one of them became pre-eclamptic. There were no statistically significant differences in urine albumin and creatinine concentrations nor in the albumin/creatinine ratio between those women who developed pregnancy-induced hypertension and those who did not. Microalbuminuria testing had a specificity of 0.95 (95% CI: 0.88 - 0.99) and a sensitivity of 0.11 (95% CI: 0.03 - 0.48). The albumin/creatinine ratio had a specificity of 0.98 (95% CI: 0.92 - 1.0) and a sensitivity of 0.22 (95% CI: 0.03 - 0.6). The albumin/creatinine ratio was significantly lower in women who delivered prematurely. We conclude that mid-trimester testing for microalbuminuria and the measurement of the urinary albumin/creatinine ratio are not effective tools for the early recognition of pregnancy-induced hypertension in healthy pregnant women.